Neurology Practice Questions

Q: A 35-year-old patient presents with numbness over the neck. On examination, decreased pain and temperature sensation is found in the distribution of C4 and C5 dermatomes. Scalp sensation, cranial nerve function, and limb examination are normal. Bladder and bowel sphincter control are normal. What is the diagnosis?

An intramedullary tumor. ### Explanation The clinical presentation of **dissociated sensory loss** (loss of pain and temperature with preserved touch/proprioception) in a specific dermatomal distribution (C4–C5) is the hallmark of a **central cord syndrome**, most commonly caused by an **intramedullary tumor** (e.g., ependymoma) or syringomyelia [1]. **Why Intramedullary Tumor is correct:** The spinothalamic tract fibers, which carry pain and temperature, decussate in the **anterior white commissure** of the spinal cord. A lesion expanding from the center of the cord (intramedullary) first compresses these crossing fibers at the level of the lesion. This results in a "suspended sensory loss" or "cape-like" distribution. Because the lesion is central, the peripherally located sacral fibers and long tracts (motor and dorsal columns) are initially spared, explaining the normal limb examination and bladder/bowel control. **Why other options are incorrect:** * **Amyotrophic Lateral Sclerosis (ALS):** This is a pure motor neuron disease involving both upper and lower motor neurons. It does **not** present with sensory loss. * **Neurosyphilis (Tabes Dorsalis):** This involves the **dorsal columns**. It would present with loss of vibration and proprioception (sensory ataxia) rather than pain and temperature loss. * **AIDP (Guillain-Barré Syndrome):** This is a peripheral demyelinating process typically presenting with ascending symmetrical paralysis and areflexia, not a localized dermatomal sensory dissociation. **NEET-PG High-Yield Pearls:** * **Dissociated Sensory Loss:** Loss of pain/temp + Preserved touch/vibration = Central Cord Lesion. * **Sacral Sparing:** A key feature of intramedullary lesions because sacral fibers are located most peripherally in the spinothalamic tract. * **Most common intramedullary tumor in adults:** Ependymoma. * **Most common intramedullary tumor in children:** Astrocytoma.

Q: A 68-year-old man presents with delirium secondary to a urinary tract infection. Following successful treatment of the infection, his mental status improved, but he exhibits persistent disorientation, impaired short-term memory, difficulty naming objects, and poor concentration. His family reports an 8-month history of gradual cognitive decline. He is now unable to manage finances and has a history of getting lost twice while driving. Post-discharge, he has urinary incontinence and an unsteady gait requiring assistance. Which disorder most likely accounts for this patient's dementia?

Normal pressure hydrocephalus. **Explanation:** The clinical presentation highlights the classic triad of **Normal Pressure Hydrocephalus (NPH)**, often remembered by the mnemonic **"Wet, Wobbly, and Wacky."** 1. **Wacky (Cognitive Decline):** The patient has an 8-month history of gradual cognitive impairment (disorientation, memory loss, and executive dysfunction like inability to manage finances). 2. **Wobbly (Gait Disturbance):** He exhibits an unsteady gait requiring assistance. In NPH, this is typically a "magnetic gait" (short steps, feet appearing stuck to the floor). 3. **Wet (Urinary Incontinence):** The development of incontinence post-infection indicates a persistent neurological issue rather than just the acute UTI. **Why the other options are incorrect:** * **Creutzfeldt-Jakob Disease (CJD):** Characterized by *rapidly* progressive dementia (weeks to months) and myoclonus. An 8-month gradual decline is too slow for typical CJD. * **Huntington Disease:** Presents with choreiform movements and psychiatric symptoms, usually in younger patients (30s–40s), with a strong autosomal dominant family history. * **Parkinson Disease:** While it features gait issues, the primary symptoms are resting tremor, rigidity, and bradykinesia. Dementia in PD typically occurs many years *after* the onset of motor symptoms. **NEET-PG High-Yield Pearls:** * **Pathophysiology:** NPH is caused by impaired CSF resorption at the arachnoid villi, leading to ventricular enlargement with *normal* opening pressure on lumbar puncture. * **Diagnosis:** MRI shows ventriculomegaly out of proportion to sulcal atrophy (Evans Index >0.3). * **Treatment:** It is a **reversible cause of dementia**. The "Miller Fisher Test" (large volume lumbar puncture) is used to see if symptoms improve; definitive treatment is a **Ventriculoperitoneal (VP) shunt**.

Q: A 12-year-old boy presents with a history of progressively increasing difficulty in walking and frequent falls. Physical examination reveals an ataxic gait and nystagmus. All deep tendon reflexes are absent, and the plantar response is extensor. What is the most likely diagnosis?

Friedreich's Ataxia. ### Explanation The clinical presentation of a young patient with progressive ataxia, nystagmus, absent deep tendon reflexes (DTRs), and extensor plantar response (Babinski sign) is classic for **Friedreich’s Ataxia (FRDA)**. **Why Friedreich’s Ataxia is correct:** FRDA is an autosomal recessive trinucleotide repeat (GAA) disorder affecting the *FXN* gene (frataxin). The pathology involves the degeneration of: 1. **Posterior Columns:** Loss of vibration and position sense. 2. **Spinocerebellar Tracts:** Leading to gait and limb ataxia. 3. **Corticospinal Tracts:** Resulting in upper motor neuron signs (extensor plantar response). 4. **Dorsal Root Ganglia:** Leading to the loss of DTRs (lower motor neuron component). The combination of **absent DTRs (LMN sign) + extensor plantar (UMN sign)** is a high-yield clinical hallmark of FRDA. **Why other options are incorrect:** * **Subacute Combined Degeneration (SCD):** Caused by Vitamin B12 deficiency. While it involves posterior columns and corticospinal tracts, it typically presents in adults and is associated with megaloblastic anemia, not primary cerebellar signs like nystagmus. * **Becker’s Muscular Dystrophy:** An X-linked recessive disorder characterized by proximal muscle weakness and pseudohypertrophy of calves. It does not present with ataxia or UMN signs. * **Tabes Dorsalis:** A late manifestation of neurosyphilis. It involves the posterior columns (sensory ataxia and absent DTRs) and presents with Argyll Robertson pupils, but it does not typically cause nystagmus or extensor plantar responses. **NEET-PG High-Yield Pearls:** * **Most common** hereditary ataxia. * **Genetic defect:** GAA repeat on Chromosome 9. * **Associated features:** Hypertrophic cardiomyopathy (most common cause of death), Diabetes Mellitus, and skeletal deformities (Kyphoscoliosis, Pes Cavus). * **Key Triad:** Progressive ataxia + Absent DTRs + Extensor Plantar.

Q: What is the diagnosis of this patient?

Muscular dystrophy. ***Muscular dystrophy*** - Characterized by **pseudohypertrophy of calves** and **proximal muscle weakness**, particularly affecting hip and shoulder girdles. - **Gower's sign** (using hands to climb up legs when rising from floor) is a classic clinical feature indicating proximal weakness. *Myasthenia gravis* - Presents with **fluctuating weakness** that worsens with activity and improves with rest, particularly affecting **ocular** and **bulbar muscles**. - Associated with **acetylcholine receptor antibodies** and shows improvement with **anticholinesterase medications**. *Congenital myopathy* - Usually presents in **infancy** with **hypotonia** and delayed motor milestones, not progressive weakness. - Muscle biopsy shows specific **structural abnormalities** like central cores or nemaline rods, without pseudohypertrophy. *Inclusion body myositis* - Typically affects **elderly patients** (>50 years) with **asymmetric weakness** involving both proximal and distal muscles. - Characterized by **rimmed vacuoles** on muscle biopsy and poor response to immunosuppressive therapy.

Q: A 16-year-old male presents with complaints of seeing wave-like visual disturbances and sudden monocular blindness, occurring while watching movies. What is the most likely diagnosis?

Migraine. ### **Explanation** **Correct Option: A. Migraine** The clinical presentation of wave-like visual disturbances (scotomas or fortification spectra) followed by sudden monocular blindness (amaurosis fugax) is characteristic of **Retinal Migraine** or migraine with aura. In adolescents, visual triggers such as flickering lights from a movie screen are well-known precipitants for migraine attacks. The "wave-like" disturbances represent the spreading depression of cortical or retinal activity, leading to transient neurological deficits. **Analysis of Incorrect Options:** * **B. Exhibitionism:** This is a paraphilic disorder involving the urge to expose one's genitals to unsuspecting strangers. It has no neurological or visual symptoms and is entirely unrelated to the clinical vignette. * **C. Temporal Lobe Epilepsy (TLE):** While TLE can present with visual hallucinations (usually complex scenes or "deja vu"), it typically involves automatisms, altered consciousness, or olfactory/gustatory sensations. It does not typically cause monocular blindness. * **D. Grand Mal Epilepsy (Tonic-Clonic Seizure):** This involves a sudden loss of consciousness followed by generalized tonic and clonic muscle contractions. While a "prodrome" may exist, the focal visual symptoms described are more specific to migraine or focal occipital seizures, not generalized grand mal epilepsy. **NEET-PG High-Yield Pearls:** * **Retinal Migraine:** Defined by fully reversible monocular visual phenomena (scintillations, scotoma, or blindness) associated with a headache. * **Acephalgic Migraine:** Migraine aura occurring without the subsequent headache, common in the pediatric/adolescent age group. * **Visual Triggers:** Photosensitivity is a hallmark of both migraine and certain types of epilepsy (reflex epilepsy), but the specific description of "wave-like" patterns strongly favors migraine.

Q: All of the following are true about Juvenile Myoclonic Epilepsy, except:

Focal seizures. Explanation: Juvenile Myoclonic Epilepsy (JME), also known as Janz Syndrome, is the most common form of **Idiopathic Generalized Epilepsy (IGE)**. By definition, generalized epilepsies involve both cerebral hemispheres from the onset, making **focal seizures** (Option A) inconsistent with the diagnosis [1], [3]. While JME patients may rarely exhibit focal EEG abnormalities, the clinical seizure semiology remains generalized. * **Why Option A is correct:** JME is a generalized epilepsy syndrome. Focal seizures originate from a localized network in one hemisphere and are not a characteristic feature of JME [3]. * **Why Option B is incorrect:** Generalized Tonic-Clonic Seizures (GTCS) are seen in nearly 90% of JME patients, typically occurring shortly after awakening [2]. * **Why Option C is incorrect:** Myoclonic jerks (sudden, involuntary muscle contractions) are the hallmark of JME [2]. They characteristically involve the upper extremities and occur most frequently in the morning. * **Why Option D is incorrect:** Sodium Valproate is the **drug of choice** for JME, providing excellent seizure control in over 80% of patients [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Age of Onset:** Typically between 12–18 years [2]. * **Classic Triad:** Myoclonic jerks (100%), GTCS (90%), and Absence seizures (one-third of patients) [2]. * **Triggers:** Sleep deprivation, alcohol consumption, and flickering lights (photosensitivity) [2]. * **EEG Findings:** Characteristic **4–6 Hz polyspike-and-wave** discharges [1], [2]. * **Prognosis:** Excellent control with medication, but usually requires **lifelong treatment** as relapse rates are high (up to 90%) upon drug withdrawal [2].

Question 1

A 35-year-old patient presents with numbness over the neck. On examination, decreased pain and temperature sensation is found in the distribution of C4 and C5 dermatomes. Scalp sensation, cranial nerve function, and limb examination are normal. Bladder and bowel sphincter control are normal. What is the diagnosis?

Accepted Answer

An intramedullary tumor

Answer

Amyotrophic lateral sclerosis

Answer

Neurosyphilis

Answer

Acute inflammatory demyelinating polyneuropathy (AIDP)

Question 2

A 68-year-old man presents with delirium secondary to a urinary tract infection. Following successful treatment of the infection, his mental status improved, but he exhibits persistent disorientation, impaired short-term memory, difficulty naming objects, and poor concentration. His family reports an 8-month history of gradual cognitive decline. He is now unable to manage finances and has a history of getting lost twice while driving. Post-discharge, he has urinary incontinence and an unsteady gait requiring assistance. Which disorder most likely accounts for this patient's dementia?

Accepted Answer

Normal pressure hydrocephalus

Answer

Creutzfeldt-Jakob disease

Answer

Huntington disease

Answer

Parkinson disease

Question 3

A 12-year-old boy presents with a history of progressively increasing difficulty in walking and frequent falls. Physical examination reveals an ataxic gait and nystagmus. All deep tendon reflexes are absent, and the plantar response is extensor. What is the most likely diagnosis?

Accepted Answer

Friedreich's Ataxia

Answer

Subacute Combined Degeneration of Cord

Answer

Becker's Muscular Dystrophy

Answer

Tabes Dorsalis

Question 4

In Bell's palsy, in which part of the face is a neurological lesion typically seen?

Accepted Answer

Upper and lower parts of one half of the face

Answer

Upper part of the face

Answer

Lower part of one half of the face

Answer

Upper and lower parts of the opposite side of the face

Question 5

What is the diagnosis of this patient?

Accepted Answer

Muscular dystrophy

Answer

Myasthenia gravis

Answer

Congenital myopathy

Answer

Inclusion body myositis

Question 6

Which of the following is NOT true regarding Frontotemporal Dementia (FTD)?

Accepted Answer

FTD typically presents with a rapid onset and static course.

Answer

Semantic dementia can be a subtype of FTD.

Answer

Nonfluent aphasia can be a feature of FTD.

Answer

Apathetic or disinhibited personality changes can occur in FTD.

Question 7

A 23-year-old man complains of intermittent double vision and fatigue. The symptoms are worse at the end of the day, and he has stopped working as a courier because of easy leg fatigue and weakness. He finds that the symptoms improve with rest. On physical examination, there is weakness of the eyelids, masticatory muscles, and thigh flexors. Having him look up at the ceiling for a long time brings on his double vision. There is no sensory abnormality, and reflexes are normal. Which of the following treatments is contraindicated in this patient?

Accepted Answer

Anticholinergic drugs

Answer

Surgery

Answer

Plasmapheresis

Answer

Cyclophosphamide

Question 8

In herpes encephalitis, all of the following are true, except?

Accepted Answer

CT scan is better than MRI

Answer

Focal symptoms are common

Answer

The temporal lobe is involved

Answer

MRI is diagnostic

Question 9

A 16-year-old male presents with complaints of seeing wave-like visual disturbances and sudden monocular blindness, occurring while watching movies. What is the most likely diagnosis?

Accepted Answer

Migraine

Answer

Exhibitionism

Answer

Temporal lobe epilepsy

Answer

Grand mal epilepsy

Question 10

All of the following are true about Juvenile Myoclonic Epilepsy, except:

Accepted Answer

Focal seizures

Answer

Generalized seizures

Answer

Myoclonus

Answer

Responses to sodium valproate

Neurology — MCQs

Neurology — MCQs

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